Screening for prediabetes and type 2 diabetes in dental offices

ObjectivesMost Americans see dentists at least once a year. Chair-side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c 5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices. MethodsWe recruited 1,033 adults 30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population 30 years of age. ResultsIndividuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self-reported body mass index 35kg/m(2) (severe obesity) or random capillary glucose 110mg/dl. We estimate that 30 percent of patients 30 years of age seen in these general dental practices had dysglycemia. ConclusionsThere is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair-side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high-risk patients. Practical implicationsFurther studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost-effectiveness of chair-side screening.